It is not enough to ask patients, you have to observe and work with them
2007 I used to work in a foundation that made research on training and employment. Due to its prestige, the Spanish Labor Ministry asked the foundation to conduct a research to identify the main employment trends for Spain in 2012 so that the government could define its employment policies. The research was conducted by one of Spain’s leading university professors in the field and he designed really an excellent quantitative Project. Under the premise that frame conditions would not change, all scenarios appeared very positive; the most optimistic forecasted full employment. Six months later, reality destroyed those beautiful forecasts. My boss, who was addressed by the Ministry, was not stupid, neither the professor nor the experts from the Ministry, nor the participating economists and sociologists. But none could foresee economic crisis one year before it exploded.
Why am I telling this? Deliberately I use this example because it was a first class study. Often quantitative studies that are used for decision making cannot see reality. If it was not like that new product launches wouldn’t fail in a range from 38% (most successful companies) to 55% (less successful companies), according to Stage Gate data.
This is why many organizations, also from the healthcare sector- use qualitative research, especially focus groups, in order to know customer needs. As Javier Megías in his excellent post “all customers lie” (in Spanish), from which I also take the cartoon to illustrate focus groups’ limitations, points, if you as a customer directly what he needs, he will answer he needs a cheaper product or service. For Javier Megías, the key is not asking them what they need, but understand what problem they need to solve, understand their context, identify the importance of the problem in their lives and other variables. To find these variables out “it is not enough to ask customers. It is necessary to observe them, empathize with them, feel their frustration and see how it affects the rest of their lives (customers do not stop time and isolate themselves to consume, although we study them as if it was like that).”
What Javier Megías is demanding are so called customer insights, in our case patient insights (including families, caregivers, physicians, nurses, etc., since the healthcare context is very complex). Traditionally insights are obtained via participant observation. Participant observation doesn’t have to be as slow as an academic ethnography, which can take one or more years. There are quicker ways to do it thanks to digital media and with a significant impact on sales, as this interesting and funny article on anthropologists in bars (Harvard Business Review) proves. Academic ethnography is the adequate tool in complex cases, like this one of schizophrenia with depression. But if we need to design a new service in a hospital or improve sales of a drug, the quick version of ethnography (3 months) might be more useful.
For instance, ethnographic work with physicians at Recombine, allowed us to identify resistances of physicians towards genetic testing and understand that they were related with their busy day to day work; while genetic sciences drives at the speed of a sports car while the ability of gynecologists to absorb and digest what genetics means for their practice moves at a steam train’s speed. We also understood their worries about the drop in patient’s numbers and their fear to introduce something that could mean more costs for their patients, But we also discovered their fear from litigation, as well as the dark side of some doctors that are able to prescribe solutions like amniocentesis because they get money for each prescription, even if this means an abortion or the birth of a child with a monogenic rare disease.
About patients we understood that they are afraid of genetics, which is associated in their minds to designer babies and to the possibility that their genetic data might be disclosed and misused. They show mistrust towards agents they cannot name exactly, but they relate them to the State, insurance companies and even secret service. We also understood that expectations towards genetics are much higher than what genetic is really capable off: some of them think genetics are almighty and can detect any kind of disease as if they were ruled by genetic determinism.
All these insights have allowed to create a pull and push strategy for Recombine, working out with doctors the differentiating factor of a preconceptional test, helping them to understand that they have not to prescribe Recombine but rather inform patients and letting choose them, as well as assessing them on how to reduce the risk of litigation. Regarding patients, knowing their fears about genetics, they are informed about the genetic risks for their babies and how to avoid them.
Applications for the pharma industry
Another example was a Project for a pharmaceutical company that wanted to know why doctors prescribed certain drugs for chronic obstructive pulmonary disease (COPD). The project was conducted by Joan Vinyets, at that time working for “A Piece of Pie”. He managed to convince physicians to do ethnographic work about their daily experiences with patients using pre-designed and easy to use ethnographic tools. For confidentiality reasons we cannot disclose the obtained results, but we can tell that the company could improve its sales thanks to the insights obtained.
Co-creation and empowerment tools
Ethnography works very well when it comes to understand user contexts, but from a practical perspective, the best way to get patient insights and at the same time produce results for the organization are co-creation projects and empowerment tools. Thanks to them, leading hospitals design their patient services and pharma companies create their “beyond the pill” strategies. More about it in the next post.